Project Summary/Abstract Traumatic brain injury is a significant health problem in a large number of military personnel returning from Iraq and Afghanistan. Unfortunately, many individuals with mild traumatic brain injuries stemming from exposure to blasts or other accidents do not get properly evaluated and treated, due to the subtle nature of their injuries. Moreover, the brain changes associated with mild traumatic brain injury often go undetected with standard brain imaging. Other issues, such as coexisting emotional disorders, the stigma of a possible mental disability, their young age, and the lack of awareness of such cognitive changes, can each affect outcome and further complicate recovery. The current study proposes to conduct a comprehensive battery of tests in returning veterans with mild traumatic brain injury in order to document impairments in cognitive skills, such as reasoning and problem solving. Such abilities are critical as our veteran patients attempt to return to work and school. In addition, we will use a recently developed form of MRI brain imaging, known as diffusion tensor imaging, which can identify subtle brain changes that are not detected with standard MRI scans. In this way, we will be able to identify cognitive deficits and their relationship to brain injury in this patient group. This study will help us to disentangle difficulties stemming from other co-existing symptoms, such as emotional disorders, versus those problems stemming directly from trauma to the brain. Improved diagnostics and treatment for our veteran patients with traumatic brain injury is critically needed. Data from this study will provide important information regarding the characteristic cognitive profile of patients with mild traumatic brain injury and provide direction for proper diagnostic and treatment procedures within the VA system. Moreover, findings from this study will clarify the brain basis of cognitive deficits in this patient group. PUBLIC HEALTH RELEVANCE: Project Narrative The current study is aimed at identifying and characterizing the range of deficits experienced by veterans returning from Iraq and Afghanistan who have sustained mild traumatic brain injuries following exposure to blasts and other accidents. Due to the subtlety of deficits associated with mild traumatic brain injury, patients are often not adequately evaluated or diagnosed. When they attempt to return to work or school, many of our veterans experience difficulty due to lapses in memory, concentration, and other thinking skills. Since many of the standardized tasks traditionally used with this patient group are not sensitive to the subtle nature of their deficits, we will test patients on newer tests that are more similar to everyday tasks. In addition, we will use a new form of MRI brain imaging, called diffusion tensor imaging, that will allow us to detect subtle brain changes in this patient group that cannot be detected with standard clinical scans. In this way, we can help identify the neurologic basis of deficits in veterans with mild traumatic brain injury and disentangle these neurologic causes from other psychological causes, such as emotional changes. Data from this study will be directly translatable into the clinical realm, as it will provide critical information regarding the characteristic cognitive profile of patients with mild traumatic injury and provide direction for proper diagnostic and treatment procedures within the VA system. Experimental findings from this study can be directly used to aid in devising new strategies for rehabilitation in patients with mild traumatic injury. The findings will provide a basis for strategies to ultimately improve our patients' problem solving and multi-tasking abilities, which will in turn facilitate their ability to return to work and school. Brain imaging findings from this study will provide the basis for improved diagnostics for mild traumatic brain injury at the VA, as well as clarify the brain basis of cognitive deficits in this patient group.